Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia.
School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia.
JAMA Ophthalmol. 2018 Sep 1;136(9):1051-1061. doi: 10.1001/jamaophthalmol.2018.2620.
Age-related macular degeneration (AMD) is a leading cause of vision impairment. It is imperative that AMD care is timely, appropriate, and evidence-based. It is thus essential that AMD systematic reviews are robust; however, little is known about the quality of this literature.
To investigate the methodological quality of systematic reviews of AMD intervention studies, and to evaluate their use for guiding evidence-based care.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies that self-identified as a systematic review in their title or abstract or were categorized as a systematic review from a medical subject heading and investigated the safety, efficacy and/or effectiveness of an AMD intervention were included. Comprehensive electronic searches were performed in Ovid MEDLINE, Embase, and the Cochrane Library from inception to March 2017. Two reviewers independently assessed titles and abstracts, then full-texts for eligibility. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Study characteristics (publication year, type of intervention, journal, citation rate, and funding source) were extracted.
Of 983 citations retrieved, 71 studies (7.6%) were deemed eligible. The first systematic review relating to an AMD intervention was published in 2003. More than half were published since 2014. Methodological quality was highly variable. The mean (SD) AMSTAR score was 5.8 (3.2) of 11.0, with no significant improvement over time (r = -0.03; 95% CI, -0.26 to 0.21; P = .83). Cochrane systematic reviews were overall of higher quality than reviews in other journals (mean [SD] AMSTAR score, 9.9 [1.2], n = 15 vs 4.7 [2.2], n = 56; P < .001). Overall, there was poor adherence to referring to an a priori design (22 articles [31%]) and reporting conflicts of interest in both the review and included studies (16 articles [23%]). Reviews funded by government grants and/or institutions were generally of higher quality than industry-sponsored reviews or where the funding source was not reported.
There are gaps in the conduct of systematic reviews in the field of AMD. Enhanced endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement by refereed journals may improve review quality and improve the dissemination of reliable evidence relating to AMD interventions to clinicians.
年龄相关性黄斑变性（AMD）是导致视力损害的主要原因。及时、适当和基于证据的 AMD 护理至关重要。因此，AMD 系统评价必须具有稳健性；然而，对于该文献的质量知之甚少。
调查 AMD 干预研究系统评价的方法学质量，并评估其用于指导基于证据的护理的能力。
本系统评价遵循系统评价和荟萃分析的首选报告项目声明。所有在标题或摘要中自称为系统评价的研究，或根据医学主题词归类为系统评价，并调查 AMD 干预措施的安全性、疗效和/或有效性的研究均被纳入。从成立到 2017 年 3 月，在 Ovid MEDLINE、Embase 和 Cochrane 图书馆中进行了全面的电子检索。两名评审员独立评估标题和摘要，然后评估全文的合格性。使用评估系统评价方法学质量（AMSTAR）工具评估质量。提取研究特征（出版年份、干预类型、期刊、引用率和资金来源）。
在检索到的 983 条引文中有 71 篇研究（7.6%）被认为符合条件。第一篇与 AMD 干预相关的系统评价于 2003 年发表。超过一半的研究是在 2014 年以后发表的。方法学质量差异很大。平均（SD）AMSTAR 评分为 11.0 的 5.8（3.2），随时间无显著改善（r=-0.03；95%CI，-0.26 至 0.21；P=0.83）。Cochrane 系统评价的质量总体上高于其他期刊的评价（平均[SD]AMSTAR 评分，9.9[1.2]，n=15 与 4.7[2.2]，n=56；P<0.001）。总体而言，在参考预先设计和报告综述和纳入研究的利益冲突方面，报告的依从性较差（22 篇文章[31%]）（16 篇文章[23%]）。政府拨款和/或机构资助的综述通常比行业赞助的综述或未报告资金来源的综述质量更高。
AMD 领域的系统评价在实施方面存在差距。被审查期刊对系统评价和荟萃分析的首选报告项目声明的增强认可，可能会提高综述质量，并改善 AMD 干预措施相关可靠证据向临床医生的传播。
